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Medicare Part D 2007 Implementation Materials
Information and Advice for Safety Net Providers

Presented in partnership with Lifelong Medical Care,
with financial support from the
California Health Care Foundation

Although open-enrollment has ended for some, many patients will need help navigating Medicare Part D year-round.

California Safety Net Providers will continue to be called upon to assist with:

  • Plan Selection - for Duals choosing to change plans, during Special Enrollment Periods, or for new Dual or Medicare eligible patients.

  • Low-Income Subsidy Applications - for new Medicare eligible patients, those who did not previously apply, or newly qualify for LIS.

  • Exceptions and Appeals - to achieve coverage for non-formulary or restricted medications.

  • Problem-Solving - to correct glitches related to plan enrollment, LIS status, coverage or co-pays.

The following tools and practical materials will be useful throughout 2007 for reference or when training staff to assist patients with Medicare prescription drug coverage:

Duals and Medicare Advantage Plans in
2007: Caution! (pdf)

Problem Solving Update: Enrollment Options (pdf)

Problem-Solving Update: Maximizing Coverage
in 2007 (pdf)

Problem Solving Update: LIS 2007 (pdf)

How to Help Patients Choose a Part D Plan (Revised) (pdf)

Zero Premium Plans for California Duals in 2007 (pdf)

Exceptions and Appeals: A Problem-Solving Guide From the National Senior Citizens Law Center (pdf)

The following Official Bulletins and Forms will be useful through 2007 to facilitate interaction between the provider, the patient, the pharmacist and the Part D plan:

Emergency Medi-Cal Bulletin (1/5/07) (pdf)
This Medi-Cal Bulletin includes useful contact information for the California benchmark plans.

Pharmacy Request for Information or Change Form (pdf)
A CMS approved fax form for pharmacies to communicate with providers. Notifies prescribing physician when follow-up is necessary.

Request for Coverage Determination Form (pdf)
Used to initiate an exception request. A CMS approved model form for requesting coverage for medically necessary Part D medications that are not on a Plan's formulary, or when other barriers to access are imposed by the Plan.

 

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